Postpartum partial cystectomy through the vagina in a mare with everted partially necrotic bladder.

The article describes the medical intervention of a large horse, specifically a Clydesdale mare, that had its bladder everted or turned inside out into the vagina after giving birth. The medical team performed a surgery which included repositioning the bladder, removing the diseased portion, and taking measures to prevent the recurrence of the condition.

About the Case

• The 750-kg Clydesdale mare had an unusual case where the bladder had everted through the urethra into the vagina after giving birth. The condition recurred four days later after the bladder was initially manually repositioned back to the peritoneal cavity.
• The everted bladder had become swollen (edematous) and a significant area of its fundus (base) had become necrotic or dead.
• Despite these complications, the animal was still able to excrete urine through both ureters, whose openings could be seen on the turned-out surface of the bladder.

Medical Intervention

• To address the situation, the horse was given an epidural injection of xylazine for perineal analgesia. This medication served to numb the area surrounding the horse’s anus and vulva, making the proceeding intervention less distressing for the animal.
• The necrotic section of the bladder was then cut out – a procedure known as a resection. Following this, the remaining edges of the healthy bladder tissue were stitched together in a double layer of simple continuous sutures.
• The operation also included a longitudinal incision of the urethral sphincter through the vaginal wall. This procedure made it possible for the everted bladder to be repositioned back into the urethra (reinverted).

Prevention of Recurrence and Recovery

• A ‘purse-string’ suture was used on the opening of the urethra to decrease its diameter, thereby reducing the risk of recurrence of the bladder evertion into the vagina.
• A Foley catheter was inflated in the bladder and kept in place for five days. This has likely been done to ensure free drainage of urine post-surgery and to minimize pressure on the sutured area of the bladder.
• After the removal of the catheter, the mare was able to urinate normally. This suggests a successful recovery from the procedure.